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REQUEST APP

 

PAWS DOG

APPLICATION REQUEST

 

PAWS will be accepting application requests April 1, 2017 through June 30, 2017. After June 30 the application process will be closed until 2018.

 

From April 1 - June 30 please review the Application Process and Frequently Asked Questions before completing the Application Request Form.  Once PAWS receives an Application Request, it will be reviewed to determine if the applicant meets PAWS' program guidelines. Qualifying applicants will be mailed an application to complete and non-qualifying applicants will receive a notice. Please note that completing the Application Request or the PAWS Dog Application does not guarantee acceptance as a PAWS Client. 

If you are a current client interested in applying for a Successor Dog please contact our Client Services Team at 616-877-7292

 

Request an Application


Applicant First Name (*)
Please type your full name.

(This form MUST be completed in the name of the applicant)

Applicant Last Name(*)
Please type your last name.

Applicant Birth Date(*)
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mm.dd.yyyy Please note that applications for Service Dogs for Children with Autism must be received prior to the child's 7th birthday.

Name of person completing this form(*)

Relation to Applicant(*)
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Applicant Phone Number(*)
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xxx-xxx-xxxx

Alternate Phone Number
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How did you hear about Paws With A Cause?(*)
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Address Line 1(*)
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Address listed MUST be the address of the applicant

Address Line 2
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City(*)
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State(*)
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If your state is not listed in the drop down menu, PAWS currently does not have Field Representative coverage in your area. We cannot serve areas without a Field Rep. Please check back to see if our coverage has expanded in the future.

Zip Code(*)
Please, use a valid USA zip code

E-mail(*)
Invalid email address.

PAWS contacts all applicants via e-mail. If you do not enter a valid e-mail address PAWS will not be able to contact you regarding your status or next steps.

Please understand that due to the increased demand for Assistance Dogs nationwide, the demand far outweighs the supply. Not everyone that applies will be able to receive a PAWS Assistance Dog.

I acknowledge that I have read the Admissions FAQs and Application Process(*)
Please, accept the agreements

I acknowledge that I have read the Duration and Commitment Agreement(*)
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I acknowledge that my disability has been diagnosed by a medical professional at least one year prior to submitting my application to PAWS.(*)
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I acknowledge that everyone 18 years of age and older living in my household will undergo a background screening (*)
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List any cognitive disabilities (i.e. Down Syndrome, short/long term memory loss, dementia, dyslexia, Attention Deficit Disorder and other learning disabilities)(*)
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Please answer the following questions regarding your ability to provide and care for an Assistance Dog, which may weigh as much as 90lbs.

Are you able to afford a minimum of $1000 a year for the upkeep and care of your PAWS Dog?(*)
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If no, please provide the name and phone number of the person who has agreed to assist you financially with the upkeep and care of the dog
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This person may be asked to sign a form outlining the agreement to provide financially for the upkeep and care of the dog.

Are you able to provide daily exercise for your Assistance Dog?(*)
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If no, please explain
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Are you able to take your Assistance Dog out multiple times throughout the day for bathroom breaks?(*)
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If no, please explain
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Are you able to have your Assistance Dog bathed and groomed every three months?(*)
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If no, please explain
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Are you able to practice and physically train with your Assistance Dog on a daily basis?(*)
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If no, please explain
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Please list the types and number of pets in your home (i.e. Cats - 2)(*)
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PAWS Assistance Dog will not be placed in a home with any other dog, unless it is a retired PAWS Dog or working Assistance Dog from an Assistance Dogs International or International Guide Dog Federation-accredited agency for someone else in the household. It has been our experience that other dogs in the home can interfere with the bonding and training process of the Assistance Dog Team.

If you currently own a dog, would you be willing to re-home it prior to receiving your Assistance Dog?
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Dog

Paws With A Cause is frequently asked if we have any non-shedding or hypoallergenic dogs. Before we answer the question, it helps to know what the inquiries mean by the term and why they are asking. Some people are looking for no or low-shedding dog because they do not want dog hair on their clothes/rugs/furniture, etc. Others have allergies - or family members with allergies - and are looking for what is commonly know as a "hypoallergenic dog." Contrary to popular belief, a dog's hair is not the primary problem for most people with dog allergies. Dog dander and saliva, which sticks to the dog's hair and are shed into the home or transferred to human skin or clothing when the dog is touched, are the chief allergens for most people. TO help those with dog allergies, frequent baths will reduce the allergen problem for all types of dogs. Generally, a larger dog will produce more dander than a smaller one; and a dog that barks frequently may disperse more saliva and sander into the air than a quiet dog. But there are also breed differences in the amount of allergens produced and in the amount of hair the dog will shed.

Are you or anyone in your household allergic to dogs?(*)
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If YES, what level of reaction do they have? (Signs/Symptoms)
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How will you address the person's allergies if a dog is placed in the home?
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Do you need a hypoallergenic dog?(*)
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If yes, please explain why
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Assistance Dog Type(*)
Please select one type of Assistance Dog. Then, complete application according to your response.

Hearing Dog (for a person who is deaf or hard of hearing)

Service Dog (for people with physical disabilities)

Seizure Response Dog

Service Dog for A Child with Autism (child must be between 4 - 12 years of age (PAWS must receive the application prior to a child’s 7th birthday; must have a completed Needs Assessment by a child’s 9th birthday; placement must occur prior to a child’s 12th birthday)

Combination Dog: Service and Hearing

Combination Dog: Service and Seizure

Combination Dog: Hearing and Seizure

Which type of hearing loss have you been diagnosed with?(*)
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When was the diagnosis made?(*)
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(mm/dd/year)

Which sounds do you need a Hearing Dog to alert you to?(*)
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Do you have a preference for dog size?(*)
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Please note that size preference cannot be guaranteed at this point and specific breed/size needs may increase the wait time for a dog

What is the primary disability for which you are applying for a Service Dog?(*)
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When was the diagnosis made?(*)
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(mm/dd/year)

List all other disabilities
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When was each diagnosed?
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(mm/dd/year)

What tasks or skills would you like a Service Dog to do for you?(*)
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Have you been diagnosed with epileptic seizures?(*)
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If yes, when was the diagnosis made?
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(mm/dd/year)

I understand that a PAWS Seizure Response Dog does NOT predict seizures(*)
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I understand that a PAWS Seizure Response Dog will NOT provide protection(*)
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I understand that a PAWS Seizure Response Dog will NOT guide me to safety(*)
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I understand that a PAWS Seizure Response Dog will NOT roll me over(*)
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Please tell us how often your seizures occur(*)
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What types of seizures do you have? (grand mal, petit mal, partial-complex, cluster, absence, etc.)(*)
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What tasks or skills would you like a Seizure Dog to do for you?(*)
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Has your child been diagnosed with Autism?(*)
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If yes, when was the diagnosis made?(*)
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Child's date of birth(*)
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My child exhibits (check all that apply)(*)

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My child also exhibits
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My child is currently in (check all that apply)*(*)

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My child is also currently in
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Do both parents live in the same home?(*)
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Please list all of the addresses where the child will reside(*)
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Please describe the effects of autism on the child and the family
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After you hit submit should receive an immediate on-screen confirmation followed by an e-mail.

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